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Special Clientele > Wound Care > Flashcards

Wound Care Flashcards

1
Q

What does skin consist of?

A

cells, fibers, and an extracellular matrix

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2
Q

how thick is the outer epidermis?

A

.06-.6mm

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3
Q

Five layers of the outer epidermis

A 
stratum corneum
stratum lucidum
stratum granulosum
stratum spinosum
stratum basale
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4
Q

Functions of the outer epidermis

A 
physical/chemical barrier
regulates fluid
light touch sensation
thermoregulation
excretion
vitamin D production
appearance
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5
Q

Stratum corneum

A

20-30 cells thick
3/4 thickness of the dermis
made of dead keratinocytes

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6
Q

Stratum Lucidum

A

few layers of flattened dead keratinocytes
they appear clear in microscope
ONLY in palms and soles of feet

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7
Q

What do Langerhans cells do?

A

bind antigens

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8
Q

Stratum granulosum

A

3-5 rows flattened cells

increasing concentrations of keratin & Langerhans cells

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9
Q

Stratum spinosum

A

several rows mature keratinocytes
keratinocytes look spiny
contains Langerhans cells

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10
Q

Stratum Basale

A

single row of keratinocytes that continuously divide and produce keratin.
Keratin is attached to dermis via basement membrane containing melanocytes and Merkel cells

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11
Q

What is keratin?

A

a protective protein

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12
Q

How thick is the inner dermis?

A

2-4 mm thick

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13
Q

How many layers in inner dermis & what are they?

A

2 layers that are highly vascular:

Papillary dermis & Reticular dermis

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14
Q

Papillary dermis

A

loosely woven fibers embedded in gelatinous matrix

Blisters occur at the junction of papillary dermis and basement membrane

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15
Q

Reticular dermis

A

dense, irregularly arranged connective tissue

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16
Q

Name a certain type of cell the dermis contains

A

fibroblasts that produce collagen, elastin, macrophages, and WBCs

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17
Q

Functions of the dermis

A 
supports/nourishes epidermis
houses epidermal appendages (hair, nails, glands)
infection control
thermoregulation
sensation
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18
Q

What does the subcutaneous tissue consist of?

A

adipose tissue

fascia

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19
Q

Another name for subcutaneous tissue

A

hypodermis

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20
Q

Adipose tissue

A

highly vascular, loose CT

stores fat to provide energy, cushion, insulation

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21
Q

Fascia

A

fibrous CT
separates & surrounds structures
facilitates movement between adjacent structures

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22
Q

3 types of wounds

A

superficial
partial-thickness
full-thickness (subcutaneous & subdermal

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23
Q

Superficial wounds

A

only affect the epidermis

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24
Q

Partial thickness wounds

A

involve epidermis and part of the underlying dermis

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25
Q

Full thickness wounds

A

through epidermis and dermis to the subcutaneous layer

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26
Q

Further classifications of full thickness wound

A

subcutaneous-into subcutaneous tissue

sub dermal- tendons, mm, or bone are involved

27
Q

3 phases of wound healing

A

Inflammation
Proliferation
Maturation

28
Q

Inflammation phase of wound healing & how long it lasts

A

allows body to control blood loss, fend off bacterial invasion, and signal cells needed to repair
1-10 days

29
Q

Vascular response (Inflammation stage)

A

Increased permeability of vessel walls causes local edema.
Platelets aggregate to control blood loss
Chemotactic agents attract cells needed for wound repair.

30
Q

Cellular Response (Inflammation stage)

A

WBCs go to site to destroy bacteria/debris

31
Q

Proliferation phase of wound healing & how long it lasts

A

builds new tissues & restores epithelial integrity

3-21 days but can start within 48 hours of injury

32
Q

Angiogenesis (proliferation phase)

A

buds from blood vessel walls grow into affected area, eventually connecting to form new blood vessels

33
Q

Granulation tissue (proliferation phase)

A

temp. latticework of CT that fills defect from removal of debris during inflammatory phase.
fibroblasts proliferate & migrate across wound bed.

As angiogenesis forms new vessels, stimulus for fibroblast proliferation DECREASES

34
Q

Wound contraction (proliferation phase)

A

fibroblasts–> myofibroblasts that contain actin
Pull wound margins together
Greater in full thickness wounds

Linear wounds contract faster than square or rectanglular.
Circle wounds contract SLOWEST

35
Q

Epithelialization (proliferation phase)

A

as defect is filled w/granulation tissue, epithelial cells begin to multiply and go across wound bed.
Epithelialization is slowed by low oxygen and thick debris.

Moist clean wound bed facilitate migration

36
Q

Maturation & how long it lasts

A

reorganizes scar tissue to reach max strength & function.

7 days- 2 years

37
Q

Maturation phase: rosy scar vs. pale scar

A

rosy pink: remodeling

pale scar: full remodeled

38
Q

A mature scar has how much of the original tissue’s strength?

A

80%

39
Q

Types of wound closure

A

Primary intention
Secondary intention
Tertiary intention

40
Q

Primary intention

A

simplest & fastest
incision is clean
edges are physically approximated (decreases distance keratinocytes must migrate)
heal best if there is low tension across wound & good vasculature

41
Q

What is Secondary Intention

A

When wound edges can’t be approximated

severely contaminated wounds may also be allowed to close by secondary intention

42
Q

What is needed for secondary intention?

A

granulation tissue must be built to fill wound defect
wound contraction
more time & energy needed
creates more scar tissue

43
Q

Tertiary intention (aka delayed primary closure)

A

combo of primary/secondary intention
can be used to decrease chance of infection
wound is initially cleansed then observed for a few days
Once wound is clean, it is surgically closed

44
Q

What can cause abnormal wound healing?

A 
absence of inflammation
chronic inflammation
hypogranulation
hypergranulation
hypertrophic scarring
keloids
contractures
dehiscence
45
Q

Causes for absence of inflammation

A

high dose steroids
malnourished
elderly
immune system dysfunction

Can use E stim of phys. agents to promote inflammation

46
Q

Causes for chronic inflammation

A 
Presence of foreign body
repetitive mechanical trauma
cytotoxic agents (H202, iodine)
47
Q

What is hypogranulation/

A

failure to build enough granulation tissue

48
Q

Hypogranulation is frequent in patients with:

A

diabetes

malnutrition

49
Q

Interventions for hypogranulation

A

prevent epithelial cells from migrating down sides by wiping wound edges w/gauze.
Lightly packing wound defect.
Extreme case: surgical intervention

50
Q

Hypergranulation

A

granulation tissue formation continues after wound defect has been filled.
Wound appears overgrowth.
Deters epithelialization because cells have trouble climbing up.

51
Q

How to prevent hypergranulation

A

Protect fragile epithelial cells from trauma such as: Inappropriate whirlpool use, maceration, too frequent dressing changes, adhesives, be cautious using hydrocolloid dressings.

52
Q

How to resolve hypergranulation

A

pressure over hypergranular tissue causes local ischemia
Silver nitrate
Surgical Excision

53
Q

Hypertrophic scarring is caused by

A

overproduction of immature collagen during proliferative & maturation/remodeling phases

Often associated with contractures

54
Q

Hypertrophic scarring

A

red, raised, fibrous lesion that stays within confines of the original wound
Usually regress, at least partially w/o intervention

55
Q

Interventions for hypertrophic scarring

A 
compression garments 23/7
silicone gel sheets over scarred area to break up collagen. 
Scar mobiliation
Steroid injections
Surgery
56
Q

Hypertrophic scarring is more common in wound that:

A

cross lines of tension in skin
with prolonged inflammatory phase
burns

57
Q

Keloids

A

Caused by excessive immature collagen syntheis extend beyond edges of original wound
Rarely regress independently
have growth phase, then stabilization, then intermittent periods of growth later on.

58
Q

Keloids are often associated with

A

tissue trauma

familial disposition

59
Q

Treatment for keloids

A

steroid injections

surgical excision

60
Q

Contractures

A

More common in wounds that cross a join (usually burns)

shortening of scar tissue

61
Q

Dehiscence

A

Due to insufficient collagen production or tensile strength.
wound pulls apart
Usually dehisces THEN gets infected

62
Q

Dehiscence is common in those with

A

decreased healing ability
longtime steroid user
diabetes mellitus
malnutrition

63
Q

Treatment for dehiscence

A

decrease or eliminate infection

protect from stress or tension

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